Helping medical students to acquire a deeper understanding of truth-telling.

PROBLEM: Truth-telling is an important component of respect for patients' self-determination, but in the context of breaking bad news, it is also a distressing and difficult task. INTERVENTION: We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students' attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students' reported difficulties in breaking bad news. CONTEXT: This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor-patient communication and ethics programs. OUTCOME: Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas 'truthfulness' was a concern for the content of the message, 'truth-telling' included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation. LESSONS LEARNED: Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

Collective learning within nursing clinical groups /

This qualitative study examined collective learning within nursing clinical groups. Specifically, it explored the influence of the individual on the group and the impact of the group on the individual. The study was organized using the concepts from Debbie Kilgore's theory of collective learning (1999). The sample consisted of 1 8 second-year university nursing students and 3 clinical instructors. Data were collected via individual interviews with each participant and researcher's observations during a group conference. The interviews were tape-recorded, transcribed, and analyzed using key concepts from Kilgore's framework. Several interesting findings emerged. Overall, it appeared that individual components and group components contributed to the quality and quantity of collective learning that occurred in the groups. Individually, each person's past group experiences, personality, culture, and gender influenced how that individual acted in the group, their roles, and how much influence they had over group decisions. Moreover, the situation which seemed to cause the greatest sense of helplessness and loss of control was when one of their group members was breaking a norm. They were unable to deal with such situations constructively. Also, the amount of sense of worthiness (respect) and sense of agency (control) the member felt within the group had an impact on the person's role in group decisions. Finally, it seemed that students felt more connected with their peers within the clinical setting when they were close with them on a personal and social level. With respect to the group elements, it seemed that the instructors' values and way of being were instrumental in shaping the group's identity. In group 2, there were clear examples of group consciousness and the students' need to go along with the majority viewpoint, even when it was contrary to their own beliefs. Finally, the common goal of passing clinical and dealing with the fears of being in the clinical setting brought solidarity among the group members, and there seemed to be a high level of positive interdependence among them. From the discussion and analysis of the findings, recommendations were given on how to improve the learning within clinical groups.

Developmental patterns of individiuals within a sensory-based learning environment in art education : insights emerging from a case study /

My research permitted me to reexamine my recent evaluations of the Leaf Project given to the Foundation Year students during the fall semester of 1997. My personal description of the drawing curriculum formed part of the matrix of the Foundation Core Studies at the Ontario College of Art and Design. Research was based on the random selection of 1 8 students distributed over six of my teaching groups. The entire process included a representation of all grade levels. The intent of the research was to provide a pattern of alternative insights that could provide a more meaningful method of evaluation for visual learners in an art education setting. Visual methods of learning are indeed complex and involve the interplay of many sensory modalities of input. Using a qualitative method of research analysis, a series of queries were proposed into a structured matrix grid for seeking out possible and emerging patterns of learning. The grid provided for interrelated visual and linguistic analysis with emphasis in reflection and interconnectedness. Sensory-based modes of learning are currently being studied and discussed amongst educators as alternative approaches to learning. As patterns emerged from the research, it became apparent that a paradigm for evaluation would have to be a progressive profile of the learning that would take into account many of the different and evolving learning processes of the individual. A broader review of the student's entire development within the Foundation Year Program would have to have a shared evaluation through a cross section of representative faculty in the program. The results from the research were never intended to be conclusive. We realized from the start that sensory-based learning is a difficult process to evaluate from traditional standards used in education. The potential of such a process of inquiry permits the researcher to ask for a set of queries that might provide for a deeper form of evaluation unique to the students and their related learning environment. Only in this context can qualitative methods be used to profile their learning experiences in an expressive and meaningful manner.

Exploring the events that engage graduate students in transformative learning /

This research explored the events that engaged graduate students in transformative learning within a graduate program in education. This context was chosen because one objective of a graduate program is to facilitate critical thinking and transformative learning. The question ofhow adult learners perceive and experience learning steered the direction ofthis study. However, the purpose ofthis research was to study critical incidents that led to profound cognitive and affective changes as perceived by the graduate students. Specifically, the questions to be answered were what critical incidents happened to graduate students while in the Master ofEducation program, how were the incidents experienced, and what transformation resulted? The research design evolved over the course of a year and was highly influenced by previous empirical studies and criticisms oftransformative learning theory. The overall design was qualitative and phenomenological. A critical and interpretive approach was made to empirical data collected through a critical incident questionnaire and in-depth interviews. Inductive analysis allowed theory to be built from the data by making comparisons. New questions emerged and attention was given to social context, the passage oftime, and sequence ofevents in order to give meaning and translation ofthe participants' experiences and to build the interpretive narratives. Deductive analysis was also used on the data and a blending ofthe two forms of analysis; this resulted in the development ofa foundational model for transformative learning to be built.The data revealed critical incidents outside ofthe graduate school program that occurred in childhood or adult life prior to graduate school. Since context of individuals' lives had been an important critique of past transformative learning models and studies, this research expanded the original boundaries of this study beyond graduate school to incorporate incidents that occurred outside of graduate school. Critical incidents were categorized into time-related, people-related, and circumstancerelated themes. It was clear that participants were influenced and molded by the stage oftheir life, personal experiences, familial and cultural conditioning, and even historic events. The model developed in this document fiom an overview ofthe fmdings identifies a four-stage process of life difficulty, disintegration, reintegration, and completion that all participants' followed. The blended analysis was revealed from the description ofhow the incidents were experienced by the participants. The final categories were what were the feelings, what was happening, and what was the enviromnent? The resulting transformation was initially only going to consider cognitive and affective changes, however, it was apparent that contextual changes also occurred for all participants, so this category was also included. The model was described with the construction metaphor of a building "foimdation" to illustrate the variety of conditions that are necessary for transformative learning to occur. Since this was an exploratory study, no prior models or processes were used in data analysis, however, it appeared that the model developed from this study incorporated existing models and provided a more encompassing life picture oftransformative learning.

Words on wisdom: perspective transformation in a "learning in retirement institute" /

In this study, 7 men and women with an average age of 77 were interviewed regarding their experience of attending courses at a Learning in Retirement Institute (LRI) in southern Ontario. The purpose was to explore the role of wisdom in the learning of these retirees. Explicit theories of wisdom developed by selected philosophers, psychologists, and religious thinkers were compared to the implicit theories of wisdom that respondents expressed. Further comparisons were drawn between these implicit theories of wisdom and the act of perspective transformation in transformative learning. Some evidence was found that the development of wisdom compares favourably to perspective transformation, especially with regards to the behavioural changes associated with critical self-reflection. Among all the respondents, those 3 LRI stude.its who had also moderated courses indicated that they had experienced the most opportunities for critical self-reflection. These 3 also expressed deep satisfaction in having been able to put their learnings to use as teachers. A recommendation of this study is that opportunities for sharing and acting upon the results of discourse within Learning in Retirement Institutes should be implemented. In the absence of evaluation, opportunities for praxis (such as coop placements) must be developed so that students can measure their success against objective criteria and hence attach meaning to their studies.

Displaced women professionals: an exploration of perceived learning processes during workplace transition /

This study focused on obtaining a deeper understanding of the perceived learning of female professionals during workplace transition. The women's lived experiences were explored through a feminist interpretive lens (Bloom, 1998). The study also drew upon concepts from adult learning such as barriers and facilitating factors to learning, resistance, transformative learning, and multiple ways of knowing. Five women participated in a 1 -hour interview and a focus group activity. The findings are presented under the 2 broad themes of perceived learning and factors affecting learning. The most common theme of perceived learning was participants' experience of increased self-knowledge. Additionally, while learning was thought of as a struggle, it provided either an opportunity for a reexamination of goals or a reexamination of self. Reflection by participants seemed to follow two orientations and other types of perceived learning included experiential, formal, and informal learning. In the broad theme of factors affecting learning, contradictions and conflict emerged through the examination of participants' multiple subjectivities, and within their naming of many factors as both facilitating factors and barriers to learning. The factors affecting learning themes included personal relationships, professional communities, selfesteem, attitude and emotion, the gendered experience of transition, time, and finances. The final theme explored participants' view of work and their orientations to the future. A proposed model of learning during workplace transition is presented (Figure 1 ) and the findings discussed within this proposed model's framework. Additional developmental theories of women (Josselson, 1987; Levinson & Levinson, 1996), communities of practice theories (Wenger, 1998), and career resilience theories (Pulley, 1995) are discussed within the context of the proposed model. Implications to practice for career counsellors, people going through workplace transition, human resource managers and career coaches were explored. Additionally implications to theory and future areas of research are also discussed.

An exploratory study of nurses' perceptions of their action learning experience /

Each year, the College of Nurses of Ontario (CNO) requires all registered nurses and registered practical nurses in Ontario to complete a Reflective Practice learning activity. In doing so, nurses are expected to perform a self- assessment, identify a practice problem or issue, create and implement a personal learning plan, and evaluate the learning and outcomes accomplished. The process and components of CNO's Reflective Practice program are very similar to an Action Learning activity. The purpose of this qualitative research was to explore the perceptions of 1 1 nurses who completed at least 1 Action Learning activity. Data analysis of their comments provided insight into their perceptions of the Action Learning experience, perceptions of the negative and positive characteristics of various activities within the Action Learning process, and perceptions of barriers or challenges within this experience. The author concluded that participants perceived their Action Learning activities to be a positive experience because the process focused on practice problems and issues, enhanced thinking about practice problems, and achieved practice-relevant outcomes. However, the results indicated that self-directed learning and journal writing were difficult activities for some participants, and some experienced negative emotional responses during reflection. The research concluded that barriers to implementation of Action Learning include a lack of understanding of the process and a perceived lack of support from employers.

A qualitative analysis of reflection in undergraduate and graduate programs

The purpose ofthis study was to explore various types ofreflection and to explore reflection on action, reflection as a practice, and reflection as a process. In doing this, the intent was to discover the perceived benefits of reflection in the classroom and to provide guidelines for future use at the undergraduate and graduate level. The qualitative components in this study included the data collection strategy of semistructured interviews with 2 undergraduate students, 2 graduate students, 1 undergraduate studies professor, and 1 graduate studies professor. The data analysis strategies included a within-case analysis and a cross-case analysis. Through the interviews participants discussed their experiences with the use ofreflection in the classroom. Through the completion ofthis analysis the researcher expected to discover the benefits ofreflection at this level of education, as well as provide suggestions for future use. Both undergraduate and graduate students and professors were found to benefit from the use of reflection in the classroom. The use ofreflection in the undergraduate and graduate classroom was found to improve student/teacher and student/peer relationships, foster critical thinking, allow for connections between learned theory and life experience, and improve students' writing abilities. Based on the results ofthe study the implications ofreflection for the undergraduate and graduate classroom and for further research are provided.

Effectiveness of instructional strategies based on schema theory on attention deficit disorder children

A review of the literature reveals that there are a number of children in the educational system who are characterized by Attention Deficit Disorder. Further review of the literature reveals that there are information processing programs which have had some success in increasing the learning of these children. Currently, an information processing program which is based on schema theory is being implemented in Lincoln County. Since schema theory based programs build structural, conditional, factual, and procedural schemata which assist the learner in attending to salient factors, learning should be increased. Thirty-four children were selected from a random sampling of Grade Seven classes in Lincoln County. Seventeen of these children were identified by the researcher and classroom teacher as being characterized by Attention Deficit Disorder. From the remaining population, 17 children who were not characterized by Attention Deficit Disorder were randomly selected. The data collected were compared using independent t-tests, paired t-tests, and correlation analysis. Significant differences were found in all cases. The Non-Attention Deficit Disorder children scored significantly higher on all the tests but the Attention Defici t Disorder children had a significantly higher ratio of gain between the pretests and posttests.

Valuing and encouraging critical reflection in pre-service teacher education

This qualitative study was designed to investigate aspects related to valuing and encouraging critical reflection in pre-service teacher education. An examination of the place and function of practicum logbooks as used at Covenant Canadian Reformed Teachers' College, a small private college which offers pre-service teacher education formed the core of the research. An analysis of the practicum logbooks written by five student teachers during three different practicum placements was performed at two levels. First, a content analysis served to identify general and specific categories within the practice teaching contextas a learning experience. Secondly, in-depth intuitive and thematic analyses of the entries which related specifically to reflection as a learning experience gave rise to critical questions. Throughout the process, the five participants formed an active and involved group of co-researchers, adding their voices to the narrative of the learning experience. Variables such as personality type, learning style and self-directedness added a dimension which deepened and emiched the study. The result of the study suggests that practicum logbooks form a valuable base for valuing and encouraging critical reflection in pre-service teacher education. The results also suggest that not all students appear to be equally capable of critical reflection. Recognizing that teacher education exists as a continuum appears to support the findings that in their journey along this continuum, student teachers not only move from reflection-on-action to reflection-in-action, but also from content to process to premise reflection. An awareness of contributing factors such as personality type, degree of risk-taking, preferred learning style and self-directedness on the part of teacher-educators will serve to create a climate of trust in which student teachers can safely develop critical reflection, using practicum logbooks as one possible medium.

Analyzing the learning of the taking personal and social responsibility model within a new physical education undergraduate degree program in El Salvador

EI Salvador presents an unfortunate history that includes a military regime and a civil war that together created a legacy of violence in which the country still struggle nowadays. Salud Escolar Integral (SEI) was created in 2005 as a program to combat youth violence throughout the re-formulation of physical education (PE) classes in public schools, promoting life skills learning that supports the resolution of conflicts with nonviolent ways. In 2007, SEI supported the creation of a physical e~ucation teacher education (PETE) degree at the Universidad Pedag6gica de EI Salvador (UPES), having the goal to assist pre-service teachers with a better understanding of humanistic principles. The present research analyzed if after attending all three years ofUPES PETE program, students presented high self-perception levels of competence and confidence related to attitude, skills and knowledge to teach PE within humanistic principles. Taking Personal and Social Responsibility (TPSR) was the theoretical framework used to analyze the development of humanistic principles. The study had a mixed-method longitudinal design that included questionnaires, reflection templates and interviews. In conclusion, although it is suggested that UPES should provide better support for the development of the teaching principles of empowering students and transfer learning, most of the humanistic principles were highly promoted by the program. At last, it is suggested that future research should track teachers' progress while teaching in schools, in order to analyze if the theory of promoting humanistic principles have also become a daily practice.

Breaking the silence : exploring the workplace experiences of six women with learning disabilities

In the current economic climate, employees are expected to upgrade their skills in order to remain productive and competitive in the workplace, and many women with learning disabilities! may feel doubly challenged when dealing with such expectations. Although the number of people with reported learning disabilities who enter the workforce is expected to increase, a dearth of research focuses on work-related experiences of women with learning disabilities; consequently, employers and educators often are unaware ofthe obstacles and demands facing such individuals. This qualitative narrative study sheds light on the work experiences of women with diagnosed or suspected learning disabilities. The study used semistructured interviews to explore their perspectives and reflections on learnlng in order to: (a) raise awareness of the needs of women with learning disabilities, (b) enhance their opportunities to learn in the workplace, and (c) draw attention to the need for improvement of inclusiveness in the workplace, especially for hidden disabilities. Study findings reveal that participants' learning was influenced by work relationships, the learning environments, self-determination, and taking personal responsibility. Moreover, the main accommodation requested was to have supportive and understanding work relationships and environments. Recommendations are made for future research and workplace improvements, most notably that no employees should be left behind through an employee-centered approach.

Exploring Reciprocity in International Service Learning Programs

Using aspects of grounded theory methodology, this study explored the perceptions and practical implementation of reciprocity in International Service Learning (ISL) Programs. Data were collected through interviews with nine ISL practitioners representing a variety of organizations offering international service learning programs. Findings suggest that multiple conceptualizations of ISL programs exist. ISL programs are interdisciplinary in nature and that using reciprocity as a guiding framework is problematic. Further attention is needed in relation to shifting the guiding framework of ISL programs from reciprocity to interdependence.

Reflection Reframed: The Process of Photography as Strategy for Teachers' Reflective Practice

Teacher reflective practice is described as an effective method for engaging teachers in improving their own professional learning. Yet, some teachers do not understand how to effectively engage in the reflective processes, or prefer not to formalize the process through writing a reflective journal as taught in most teacher education programs. Developing reflective skills through the process of photography was investigated in this study as a strategy to allow enhanced teacher reflection for professional and personal growth. The process of photography is understood as the mindful act of photographing rather than focusing on the final product-the image. For this study, 3 practicing educators engaged in photographic exercises as a reflective process. Data sources included transcribed interviews, participant journal reflections, and sketchbook artifacts, as well as the researcher's personal journal notes. Findings indicated that, through the photographic process, (a) teacher participants developed new and individual strategies for professional leaming; and (b) teacher participants experienced shifts in the way they conceptualized their personal worldviews.

Closing the Summer Learning Gap for Vulnerable Children: An Examination of a Summer Family Literacy Program for Junior Kindergarten Children At-Risk for Reading Difficulties

The learning gap created by summer vacation creates a significant breach in the learning cycle, where student achievement levels decrease over the course ofthe summer (Cooper et aI., 2000). In a review of 39 studies, Cooper and colleagues (1996) specified that the summer learning shortfall equals at least one month loss of instruction as measured by grade level equivalents on standardized test scores. Specifically, the achievement gap has a more profound effect on children as they grow older, where there is a steady deterioration in knowledge and skills sustained during the summer months (Cooper et aI., 1996; Kerry & Davies, 1998). While some stakeholders believe that the benefits of a summer vacation overshadow the reversing effect on achievement, it is the impact of the summer learning gap on vulnerable children, including children who are disadvantaged as a result of requiring special educational needs, children from low socioeconomic backgrounds, and children learning English as a second language, that is most problematic. More specifically, research has demonstrated that it is children's literacy-based skills that are most affected during the summer months. Children from high socioeconomic backgrounds recurrently showed gains in reading achievement over the summer whereas disadvantaged children repeatedly illustrate having significant losses. Consequently, the summer learning gap was deemed to exaggerate the inequality experienced by children from low socioeconomic backgrounds. Ultimately, the summer learning gap was found to have the most profound on vulnerable children, placing these children at an increased chance for academic failure. A primary feature of this research project was to include primary caregivers as authentic partners in a summer family literacy program fabricated to scaffold their children's literacy-based needs. This feature led to the research team adapting and implementing a published study entitled, Learning Begins at Home (LBH): A Research-Based Family Literacy Program Curriculum. Researchers at the Ontario Institute designed this program for the Study of Education, University of Toronto. The LBH program capitalized on incorporating the flexibility required to make the program adaptable to meet the needs of each participating child and his or her primary caregiver. As it has been well documented in research, the role primary caregivers have in an intervention program are the most influential on a child's future literacy success or failure (Timmons, 2008). Subsequently, a requirement for participating in the summer family literacy program required the commitment of one child and one of his or her primary caregivers. The primary caregiver played a fundamental role in the intervention program through their participation in workshop activities prior to and following hands on work with their child. The purpose of including the primary caregiver as an authentic partner in the program was to encourage a definitive shift in the family, whereby caregivers would begin to implement literacy activities in their home on a daily basis. The intervention program was socially constructed through the collaboration of knowledge. The role ofthe author in the study was as the researcher, in charge of analyzing and interpreting the results of the study. There were a total of thirty-six (36) participants in the study; there were nineteen (19) participants in the intervention group and seventeen (17) participants in the control group. All of the children who participated in the study were enrolled in junior kindergarten classrooms within the Niagara Catholic District School Board. Once children were referred to the program, a Speech and Language Pathologist assessed each individual child to identify if they met the eligibility requirements for participation in the summer family literacy intervention program. To be eligible to participate, children were required to demonstrate having significant literacy needs (i.e., below 25%ile on the Test of Preschool Early Literacy described below). Children with low incident disabilities (such as Autism or Intellectual Disabilities) and children with significant English as a Second Language difficulties were excluded from the study. The research team utilized a standard pre-test-post-test comparison group design whereby all participating children were assessed with the Test of Preschool Early Literacy (Lonigan et aI., 2007), and a standard measure of letter identification and letter sound understanding. Pre-intervention assessments were conducted two weeks prior to the intervention program commencing, and the first set of the post-intervention assessments were administered immediately following the completion of the intervention program. The follow-up post-intervention assessments took place in December 2010 to measure the sustainability of the gains obtained from the intervention program. As a result of the program, all of the children in the intervention program scored statistically significantly higher on their literacy scores for Print Knowledge, Letter Identification, and Letter Sound Understanding scores than the control group at the postintervention assessment point (immediately following the completion of the program) and at the December post-intervention assessment point. For Phonological Awareness, there was no statistically significant difference between the intervention group and the control at the postintervention assessment point, however, there was a statistically significant difference found between the intervention group and the control group at the December post-intervention assessment point. In general, these results indicate that the summer family literacy intervention program made an immediate impact on the emergent literacy skills of the participating children. Moreover, these results indicate that the summer family literacy intervention program has the ability to foster the emergent literacy skills of vulnerable children, potentially reversing the negative effect the summer learning gap has on these children.